Provider Demographics
NPI:1366770638
Name:WELLCARE HEALTH SERVICES INC.
Entity type:Organization
Organization Name:WELLCARE HEALTH SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:IGUH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:323-776-3011
Mailing Address - Street 1:3429 CRENSHAW BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-4845
Mailing Address - Country:US
Mailing Address - Phone:323-776-3011
Mailing Address - Fax:323-731-7069
Practice Address - Street 1:3429 CRENSHAW BLVD
Practice Address - Street 2:SUITE#1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-4845
Practice Address - Country:US
Practice Address - Phone:323-776-3011
Practice Address - Fax:323-731-7069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN/A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health